Scurvy (also known as Barlow disease in infants or historically, as scorbutus) is a condition characterized by an increased bleeding tendency and impaired collagen synthesis resulting in osteoporosis and impaired wound healing. It is caused by a dietary lack of vitamin C (ascorbic acid).
Scurvy in adults is rare. Young children and older persons are predisposed to scurvy due to their diet or the overheating of food. It does not occur before six months of age because maternal stores are maintained until then. Males and females are equally affected.
Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. bleeding gums), and impaired wound healing.
Unlike most other animals, humans cannot produce their own vitamin C.
Lack of dietary vitamin C (ascorbic acid) may be related to inadequate food intake, the destruction of vitamin C in food caused by cooking and canning, or the absence of fresh fruit in the diet.
Vitamin C is essential for collagen synthesis, acting as a coenzyme to producing cross-linking of collagen fibers. Defective collagen cross-linking compromises skin, joint, bone, and vascular integrity.
- generalized osteopenia
- cortical thinning: “pencil-point” cortex
- periosteal reaction due to subperiosteal hemorrhage
- scorbutic rosary: expansion of the costochondral junctions
- Wimberger ring sign: circular, opaque radiologic shadow surrounding epiphyseal centers of ossification, which may result from bleeding
- Frankel line: dense zone of provisional calcification
- Trümmerfeld zone: lucent metaphyseal band underlying Frankel line
- Pelken spur: metaphyseal spurs which result in cupping of the metaphysis
- pathological fractures
Other significant manifestations in both children and adults arise from the propensity for bleeding, including intra-articular, retrobulbar, and intracranial hemorrhage.
History and etymology
Infantile scurvy, also known as Barlow disease, is named after Sir Thomas Barlow (1845-1945), British Royal Physician.
The term scurvy comes from various words used to describe the manifestations of the condition: covered with scabs, diseased, scorbutic.
- scheurbuik (Dutch)
- scorbut (French)
- skybjugr (Old Norse): a swelling (bjugr) from drinking sour milk (skyr) on long sea voyages
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